Please print the application, then mail or fax to:
Rolling Wheels Training Center, LLC FAX: 816-478-3677
4804B Noland Rd.
Kansas City, MO 64133
OR – call 816-478-3677 for information
On-line registration and scheduling information available at www.rollingwheels.org.
Students are registered on a first come / first serve prepaid basis.
A 100% refund, less a $25.00 processing fee, will be issued if the registrant cancels the class MORE than 7 days in advance. Refunds will not be issued if the registrant cancels less than 7 days prior to the opening of the class. If the instructor determines the student is not eligible to complete the class or if the student voluntarily decides to leave the class, refunds will not be issued.
There will be a $10.00 fee to reschedule your class. You must reschedule more than 7 days in advance of your class.
A list of items and clothing to bring to class will be sent with your confirmation letter.
EARLY REGISTRATION IS SUGGESTED. - Print your name as it would appear on your driver's license.
Name Date of Birth
Business Phone Home Phone
Address
City, State & Zip
By signing below, I signify that I have read and understand the refund policy.
Applicant’s Signature: ______________________________________ Date: ________________
**If under the age of 18: Parent’s Signature
The cost for each Basic Rider Course is $215.00 as of June 1, 2007. Premium BRC cost is $280 as of May 14, 2007.
Preferred class dates: 1st choice: ______________________ 2nd choice: ______________________
Method of payment: Check Make Checks payable to: Rolling Wheels Training Center, LLC
Master Card Visa Discover _________ American Express___________
If you are using a credit card, please complete the following information.
Card Number VCODE Expiration Date
Name as it appears on the card, if different from above
Total Amount: ________________
The issuer of the card identified on this item is authorized to pay the amount shown as Total. I promise to pay such Total subject to and in accordance with the agreement governing the use of such card.
Signature & Date ______________________________________________